Workplace Violence Prevention

1. Workplace Violence Prevention

2. Overview • Defining Workplace Violence • Forms and types of workplace violence • Workplace violence injury statistics • Prevalence and risk factors • Developing a general Workplace Violence Prevention program

3. Definition • “Any act of aggression that causes physical or emotional harm, including assault (any attempt to inflict physical harm on a worker), threat, verbal abuse, sexual harassment and racial or religious harassment” (OPSEU) • “Attempted, threatened or actual conduct of a person that endangers the health and safety of the worker including any threatening statement, harassment or behaviour that gives a worker reasonable cause to believe that his/her safety is at risk (N.S. H&S Advisory Council)”

4. Workplace Violence/Client Aggression - 2004 LTI’s Ontario Health Care & Community Services Data Source: WSIB Injury Analysis by SWA Snapshot Period: July 2005

5. Workplace Violence/Client Aggression - 2004 LTI’s Data Source: WSIB Injury Analysis by SWA Snapshot Period: July 2005

6. Prevalence “Workplace violence is one of the most complex and dangerous occupational hazards facing nurses” (McPaul & Lipscomb, 2004) • Health and community care workers exposed to a variety of violent/aggressive individuals • Many still do not agree that the issue is real • Many consider violence “part of the job” • Many organizations do not have a strong violence prevention program • No protective regulations addressing workplace violence

7. Prevalence • Many papers describing and explaining the issue of workplace violence however, few intervention studies exist (Arnetz & Arnetz, 2000) • Assault rates for residential-care, nursing and personal-care workers more than ten times the rate than that of private non-health (Hewitt & Levin, 1997) • British Columbia study suggested that health care workers face similar level of risk to that of police (Boyd 1995)

8. Traditional Approaches to Aggression Prevention • Focus on methods to manage, contain or reduce the impact of the aggressive act • Rely on physical methods to deal with the situation • Focus on body containment techniques – based on a philosophy of care that focuses on pathologies which reinforces negative perceptions of persons with dementia as being assaultive, violent, dangerous and the passive recipients of care! • Do not seek to understand the underlying reason for the responsive behaviors (Jones, 1999) • Focus on containment and control of aggressive individuals (dictated care regimes, use of physical or chemical restraints)

9. Traditional Approaches to Aggression Prevention • Not tailored for the learning needs of front-line staff in long-term care homes • Are in direct contrast to the shift in culture that has occurred in dementia care in last decade - movement toward person - or relationship - centered care • Have inappropriate response techniques that may have a pervasive and profound negative impact on residents with cognitive impairment, leading to excess disability and a wounded spirit (Taft, 1995; Dawson, Wells & Kline, 1993; Rader, 1995) • Increase the risk of staff injury • Do not equip staff with the necessary knowledge and point-of-care practices to decrease risk

10. Forms • Threats of violence • Verbal and emotional abuse • Harassment based on sex, religion, sexual orientation, disability, race • Use of, or threats to use force • Inappropriate suggestions, inference, comments, or behavior • Carrying a weapon • Intimidation and aggressive behavior • Domestic Violence

11. Types(Cal/OSHA 1995) Type I (Criminal Intent): • Perpetrator has no relationship to the workplace Type II (Client/Customer): • Perpetrator is a client who becomes violent towards a worker or another client “Majority of threats and assaults against caregivers come from patients/families/visitors” (Arnetz & Arnetz, 2000) Type III (Worker-to-worker): • Perpetrators are employees or past employees Type IV (Personal Relationship): • Perpetrator usually has a relationship with an employee (e.g. domestic violence in the workplace)

12. General Risk Factors Environmental, Ergonomic & Administrative: • Crowded, noisy conditions • Overcrowded resident areas • Lack of staff education/training • Lack of security controls • Assigning staff to work alone, work in remote locations, and/or high crime areas • Understaffed areas • Lack of worker experience contributing to quality issues

13. General Risk Factors Client’s Physiological Conditions: • Systemic disorders: fluid/electrolyte imbalance, anemia, thyroid disorders, diabetes, hepatic disorders, neurological disorders, epilepsy, degenerative diseases • Toxic levels of medications • Psychiatric Conditions: psychotic symptoms & paranoia, psychogeriatric illness • Substance Abusers

14. A Guide to the Development of a Workplace Violence Prevention Program Book one:Implementing the Program in Your Organization Book two:Developing Crisis Prevention & Communication Strategies Book three:Developing Human Resources Strategies for Managing Workplace Violence Book four:Preventing Client Aggression Through Gentle Persuasive Approaches™

15. A Guide to the Development of a Workplace Violence Prevention Program Book one: Implementing the Program in your Organization Step 1 • Secure management commitment • Assess your program needs • Develop program components Step 2 and 3 • Implement program Step 4 and 5 • Evaluate program

16. Step 1 Secure Management Commitment Management commitment is: • The foundation of an effective program • Necessary to ensure that other resources are available to develop, implement and maintain the program (budget, human resources, materials, equipment, training, etc.)

17. Step 1 Secure Management Commitment Initial tasks: • Enlist senior management commitment to program • Appoint a program leader • Appoint a multidisciplinary steering committee • Determine whether committee will be an ad hoc or standing committee

18. Step 1 Assess Your Needs • Community workplace violence issues • Internal documents: • Security, emergency response, unusual occurrence, client abuse, EAP • Employee incidents/accidents • Physical environment • Work setting and clients • Point-of-care work practices • Employee perceptions

19. Step 1Assess Your Needs

20. Step 1Assess Your Needs

21. Step 1Develop the Program A comprehensive Workplace Violence Prevention program includes: • Workplace violence prevention policy • Associated procedures

22. Step 1Develop the Program Develop a Violence Prevention Policy that includes: • Employer commitment • Policy purpose and statement • Applicable definitions • Roles and responsibilities • Reporting and investigation • Risk assessment • Emergency response • Employee training • Program audit, review and revision

23. Step 1Develop the Program Violence Prevention Procedures include: • Reporting • Emergency response • Investigation • Environmental and security controls • Administrative controls • Work practices • Travel- Appendix S

24. Step 2 and 3Implement the Program Critical steps: • Ensure development of Workplace Violence Prevention policy and procedures • Develop a communication and marketing plan • Develop and present staff training • Launch the program

25. Step 2 and 3Implement the Program

26. Step 4 and 5Evaluate the Program Goals of program evaluation: • Create and maintain a safe working environment without the threat of violence • Review, revise, enhance and improve program components based on: • program self-audit • results of qualitative and quantitative evaluation procedures • Maintain the program • Continuously improve Workplace Violence Prevention program

27. A Guide to the Development of a Workplace Violence Prevention Program Book two:Developing Crisis Prevention and Communication Strategies • Staff training in crisis intervention • Recognizing and responding to stages of violence • Crisis response team • Effective communication skills • Environmental conditions during crisis interventions • Cultural sensitivity • Emergency response • Employee’s needs during and after crises

28. A Guide to the Development of a Workplace Violence Prevention Program Book three:Developing Human Resources Strategies for Managing Workplace Violence • Prevention of violence among employees • Harassment • Domestic violence • Threats • Weapons • Hiring and Termination practices

29. Resources The following OSACH Resource may be purchased from our website – http://www.osach.ca

30. Questions? Concerns? Comments?